base” should be available to agents to access in real time. This knowledge base should be rich in content, with actual, immediate and practical value to the agent and the caller. A sophisticated, effi cient search feature is essential, as well, to put the knowledge in front of the agent as it is needed.

5. Explore a “shared cost” solution in order to spread the invest- ment in an enhanced service desk across a multiple-hospital system. While ad-hoc impro- visation, offshoring or simply employing a bare-bones help desk may save money and seem to work well enough in the short term, such temporary solutions are not cost effective in the long term. Less support means that clinical professionals are not spending their valuable time doing what they are trained to do – and patient care can suffer for it.

The background of these recom- mendations is no mystery to anyone who works in today’s hospital envi-

ronment with its reliance on complex IT systems. A brief look at the conditions that drive the suggestions – and make them necessary – is worthwhile.

The traditional help desk model Traditionally, hospitals have employed either an internal help desk strategy or, more recently, an external service provider not specializing in healthcare. Some have tried to capitalize on the cost savings of offshore outsourcing. In both cases, a simple call-management and triage help desk typically is established to provide support, which often lacks the bandwidth to manage multiple cases simultane- ously. During off-peak hours and weekends, calls are either fi elded by the operations staff or, more than likely, sent to voicemail or to the hospital switchboard operator. Familiar call center models, while able to manage higher call volumes, typically employ IT generalists who lack the healthcare-specifi c expertise needed to support the electronic clinical systems and therefore are unable to achieve fi rst-call resolution of problems on a consistent basis. While they may be able to address minor support calls, such as password resets, serious problems are often passed to a single on-call person. Worse yet, the problems end up unresolved.

Improvisation as a band-aid solution Frustrated by the inability of the traditional help desk

to deal with sophisticated clinical applications, many hospitals put together their own ad-hoc support system. As described in a January 2009 publication by the Mas- sachusetts Technology Collaborative, “Saving Lives, Sav- ing Money in Practice,” hospitals participating in a study of support for computerized physician order entry (CPOE) employed a combi- nation of support methods: Physicians can call local nurses either directly or referred from the hospital help desk. There are also designated “super users,” both among experienced physicians and trained assistants. Back-up staff is also reachable on off-hours via mo- bile phone and remote observation of the user’s computer screen. Internal arrangements like this can work, but also draw nurses and physicians away from their primary responsibility, patient care.

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Cross-platform expertise In addition, today’s advanced service desk professional should be able to provide assistance between

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the major IT platforms while simultaneously dealing with the usual clinical processes. It is not suffi cient to pass a question or problem off to the Cerner group or the Epic group or the GE group because of lack of familiarity. To complicate the situation, hospitals are often in transition between platforms, so they need support between the legacy applications and the new – simultaneously. It is simply not an effi cient option to rely on two help desk support systems. The modern service desk should be able to do it all.

The total solution Ultimately, the service desk support model is one that hospital staff can call upon for a wide rage of support issues. If the infrastructure is available and performing optimally, doctors and nurses can spend more time at the bedside and less time on the phone trying to understand and resolve system issues.

Clinical IT support has often been thought of as a commodity that could be outsourced to the lowest bid- der. But forward-looking CIOs and hospital leadership now are recognizing that the effort required to support today’s users, with increasingly complex systems and applications, is in a period of unstoppable growth – and that a truly thoughtful, advanced “service desk” strategy, keyed to the clinical process, can improve quality and reduce costs.